Letter to the Editor
The use of a quality care programme for the management of renal disease in the Aragon region
Utilidad de un programa de calidad asistencial para la gestión clínica de las enfermedades nefrológicas en Aragón
Luis Miguel Lou Arnala,
, Ana Berni Wennekersb, Olga Gracia Garcíac, José Manuel Logroño Gonzálezd, Antonio Gascón Mariñoe, Mercedes García Menaf, Rosario Moreno Lópezg, Samia Etaaboudih, Orlando Martinsi, Angel Blasco Forcéna, José Esteban Ruiz Laiglesiab, On behalf of the Sociedad Aragonesa de Nefrología
Corresponding author
a Servicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, Spain
b Servicio de Nefrología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
c Servicio de Nefrología, Hospital Alcañiz, Teruel, Spain
d Servicio de Nefrología, Hospital General San Jorge, Huesca, Spain
e Servicio de Nefrología, Hospital Obispo Polanco, Teruel, Spain
f Servicio de Nefrología, Hospital San Juan de Dios, Zaragoza, Spain
g Servicio de Nefrología, Hospital de la Defensa, Zaragoza, Spain
h Servicio de Nefrología, Hospital Ernest Lluch, Calatayud, Zaragoza, Spain
i Servicio de Nefrología, Hospital de Barbastro, Barbastro, Huesca, Spain
Ver másRead
6122
Timeswas read the article
2202
Total PDF
3920
Total HTML
Share statistics
array:25 [ "pii" => "S2013251417301086" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.05.011" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "303" "copyright" => "Sociedad Española de Nefrología" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2017;37:345-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2832 "formatos" => array:3 [ "EPUB" => 318 "HTML" => 2022 "PDF" => 492 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0211699516301977" "issn" => "02116995" "doi" => "10.1016/j.nefro.2016.10.023" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "303" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia. 2017;37:345-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3138 "formatos" => array:3 [ "EPUB" => 331 "HTML" => 2263 "PDF" => 544 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Utilidad de un programa de calidad asistencial para la gestión clínica de las enfermedades nefrológicas en Aragón" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "345" "paginaFinal" => "347" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The use of a quality care program for the management of renal disease in the Aragon region" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Miguel Lou Arnal, Ana Berni Wennekers, Olga Gracia García, José Manuel Logroño González, Antonio Gascón Mariño, Mercedes García Mena, Rosario Moreno López, Samia Etaaboudi, Orlando Martins, Angel Blasco Forcén, José Esteban Ruiz Laiglesia" "autores" => array:12 [ 0 => array:2 [ "nombre" => "Luis Miguel" "apellidos" => "Lou Arnal" ] 1 => array:2 [ "nombre" => "Ana" "apellidos" => "Berni Wennekers" ] 2 => array:2 [ "nombre" => "Olga" "apellidos" => "Gracia García" ] 3 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Logroño González" ] 4 => array:2 [ "nombre" => "Antonio" "apellidos" => "Gascón Mariño" ] 5 => array:2 [ "nombre" => "Mercedes" "apellidos" => "García Mena" ] 6 => array:2 [ "nombre" => "Rosario" "apellidos" => "Moreno López" ] 7 => array:2 [ "nombre" => "Samia" "apellidos" => "Etaaboudi" ] 8 => array:2 [ "nombre" => "Orlando" "apellidos" => "Martins" ] 9 => array:2 [ "nombre" => "Angel" "apellidos" => "Blasco Forcén" ] 10 => array:2 [ "nombre" => "José Esteban" "apellidos" => "Ruiz Laiglesia" ] 11 => array:1 [ "colaborador" => "en representación de la Sociedad Aragonesa de Nefrología" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2013251417301086" "doi" => "10.1016/j.nefroe.2017.05.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301086?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699516301977?idApp=UINPBA000064" "url" => "/02116995/0000003700000003/v1_201706230110/S0211699516301977/v1_201706230110/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2013251417301104" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.05.013" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "308" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2017;37:347-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3014 "formatos" => array:3 [ "EPUB" => 310 "HTML" => 2191 "PDF" => 513 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Pulmonary haemorrhage in a patient with IgA nefropathy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "347" "paginaFinal" => "349" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemorragia pulmonar en paciente con nefropatía IgA" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 525 "Ancho" => 638 "Tamanyo" => 43474 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Alveolar-interstitial infiltrates secondary to intrapulmonary haemorrhage and haematoma.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lara Belmar Vega, Carlos Fernández-Díaz, Natalia Palmou Fontana, Emilio Rodrigo Calabia, Luis Martin Penagos, Manuel Arias Rodríguez, Gema Fernández Fresnedo" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Lara" "apellidos" => "Belmar Vega" ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Fernández-Díaz" ] 2 => array:2 [ "nombre" => "Natalia" "apellidos" => "Palmou Fontana" ] 3 => array:2 [ "nombre" => "Emilio" "apellidos" => "Rodrigo Calabia" ] 4 => array:2 [ "nombre" => "Luis" "apellidos" => "Martin Penagos" ] 5 => array:2 [ "nombre" => "Manuel" "apellidos" => "Arias Rodríguez" ] 6 => array:2 [ "nombre" => "Gema" "apellidos" => "Fernández Fresnedo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699516302028" "doi" => "10.1016/j.nefro.2016.12.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699516302028?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301104?idApp=UINPBA000064" "url" => "/20132514/0000003700000003/v1_201707070022/S2013251417301104/v1_201707070022/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2013251417301074" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.05.010" "estado" => "S300" "fechaPublicacion" => "2017-05-01" "aid" => "299" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2017;37:343-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5439 "formatos" => array:3 [ "EPUB" => 553 "HTML" => 3980 "PDF" => 906 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Prevalence and risk of progression of chronic kidney disease in diabetics and hypertensive patients followed by primary care physicians" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "343" "paginaFinal" => "345" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia y riesgo de progresión de enfermedad renal crónica en pacientes diabéticos e hipertensos seguidos en atención primaria en la Comunidad de Madrid" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Guadalupe Alemán-Vega, Isabel Gómez Cabañas, Laura Reques Sastre, Javier Rosado Martín, Elena Polentinos-Castro, Ricardo Rodríguez Barrientos" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Guadalupe" "apellidos" => "Alemán-Vega" ] 1 => array:2 [ "nombre" => "Isabel" "apellidos" => "Gómez Cabañas" ] 2 => array:2 [ "nombre" => "Laura" "apellidos" => "Reques Sastre" ] 3 => array:2 [ "nombre" => "Javier" "apellidos" => "Rosado Martín" ] 4 => array:2 [ "nombre" => "Elena" "apellidos" => "Polentinos-Castro" ] 5 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Rodríguez Barrientos" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S021169951630193X" "doi" => "10.1016/j.nefro.2016.10.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021169951630193X?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301074?idApp=UINPBA000064" "url" => "/20132514/0000003700000003/v1_201707070022/S2013251417301074/v1_201707070022/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "The use of a quality care programme for the management of renal disease in the Aragon region" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "345" "paginaFinal" => "347" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Luis Miguel Lou Arnal, Ana Berni Wennekers, Olga Gracia García, José Manuel Logroño González, Antonio Gascón Mariño, Mercedes García Mena, Rosario Moreno López, Samia Etaaboudi, Orlando Martins, Angel Blasco Forcén, José Esteban Ruiz Laiglesia" "autores" => array:12 [ 0 => array:4 [ "nombre" => "Luis Miguel" "apellidos" => "Lou Arnal" "email" => array:1 [ 0 => "lmlou@salud.aragon.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ana" "apellidos" => "Berni Wennekers" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Olga" "apellidos" => "Gracia García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "José Manuel" "apellidos" => "Logroño González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Antonio" "apellidos" => "Gascón Mariño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Mercedes" "apellidos" => "García Mena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "Rosario" "apellidos" => "Moreno López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] ] ] 7 => array:3 [ "nombre" => "Samia" "apellidos" => "Etaaboudi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0040" ] ] ] 8 => array:3 [ "nombre" => "Orlando" "apellidos" => "Martins" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">i</span>" "identificador" => "aff0045" ] ] ] 9 => array:3 [ "nombre" => "Angel" "apellidos" => "Blasco Forcén" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 10 => array:3 [ "nombre" => "José Esteban" "apellidos" => "Ruiz Laiglesia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 11 => array:1 [ "colaborador" => "On behalf of the Sociedad Aragonesa de Nefrología" ] ] "afiliaciones" => array:9 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Alcañiz, Teruel, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital General San Jorge, Huesca, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Obispo Polanco, Teruel, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital San Juan de Dios, Zaragoza, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital de la Defensa, Zaragoza, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Ernest Lluch, Calatayud, Zaragoza, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital de Barbastro, Barbastro, Huesca, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de un programa de calidad asistencial para la gestión clínica de las enfermedades nefrológicas en Aragón" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 2009, the Framework Document on Managing Chronic Kidney Disease Care in Aragon was drafted by a multidisciplinary working group that comprised healthcare professionals, healthcare management professionals and members of kidney patient associations (ALCER Aragon). A structured, decentralised clinical management model was established based on grouping patients by diseases, identifying opportunities for improvement and describing activities through their processes.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a> The patient and family were placed at the centre of the process map, and a continuous improvement cycle was introduced. Moreover, a series of indicators—both technical and perceived—were monitored to periodically assess the patient's evolution. This systematic and planned measurement of quality indicators, together with feedback and benchmarking,<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> enabled us to achieve the objectives. Moreover, activities that are unrelated to the final process were also taken into account. These are information to patients and healthcare personnel, collection of management and indicator data, training of personnel and inspection of facilities.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> In this document, we evaluate the response to this intervention by means of monitoring the main indicators.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Improvement programmes centred on the following strategic plans were established at all nephrology units:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0015" class="elsevierStylePara elsevierViewall">Recovery of the patient's role in decision-making.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0020" class="elsevierStylePara elsevierViewall">Improvement of information systems.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0025" class="elsevierStylePara elsevierViewall">Designing a registry of patients undergoing renal replacement therapy in the autonomous community.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">Resolution of structural limitations: installing water treatment units to obtain ultrapure water in hospitals lacking the same and renewing equipment at dialysis centres.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Increasing the percentage of patients on special techniques.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Improving the critical points of the care process:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">•</span><p id="par0045" class="elsevierStylePara elsevierViewall">Optimisation of management of patients with ACKD: equity, reduction in variability.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">•</span><p id="par0050" class="elsevierStylePara elsevierViewall">Promoting kidney transplants from living donors.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">•</span><p id="par0055" class="elsevierStylePara elsevierViewall">Promoting home dialysis techniques.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">•</span><p id="par0060" class="elsevierStylePara elsevierViewall">Promoting conservative kidney management.</p></li></ul></p></li></ul></p><p id="par0065" class="elsevierStylePara elsevierViewall">Analysing the main indicators after the development and implementation of the management process has allowed us to observe a significant improvement. The various clinical, nutritional, analytical and evolution-related parameters in the different RRT techniques have reached similar ranges to routine nephrology practice and are even higher than the national averages in some aspects.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> A brief selection of the changes among the other indicators is reflected in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">We feel that the involvement of healthcare personnel and patients in management and the collaboration of the healthcare authorities facilitates the implementation of programmes that may improve healthcare.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a> The implementation of the above-mentioned processes was especially difficult due to being performed at the time of the economic crisis, with significant financial limitations. The fact that the processes performed are effective (they truly improve the patients’ situations) and efficient (they improve them with a reasonable investment and in many cases actually save money) has facilitated the creation of these units and treatment techniques.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lou Arnal LM, Berni Wennekers A, Gracia García O, Logroño González JM, Gascón Mariño A, García Mena M, et al. Utilidad de un programa de calidad asistencial para la gestión clínica de las enfermedades nefrológicas en Aragón. Nefrología. 2017;37:345–347.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">UK: unknown.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">2010 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">2011 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">2012 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">2013 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">2014 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">2015 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Patients undergoing HD with ultrapure water, %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Monitors over 10 years old, %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Patients undergoing HD with special techniques, %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">HD initiated on a scheduled basis in ACKD, %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">88 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Information on RRT modalities in ACKD, %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Origin of RRT patients</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ACKD, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Not ACKD, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unscheduled, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">HD initiated with definitive vascular access</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ACKD, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">85.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">81.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Not ACKD, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unscheduled, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">eGFR at the beginning of RRT ml/min/1.73</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">ACKD patients under conservative management, %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Living donor KTx, %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Peritoneal dialysis, %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Kt/V in PHD >1.3, %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">At 3 and 6 months, %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">78 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Working peritoneal catheters per year, %</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">93 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Peritonitis per months of treatment</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/31.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/34.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/41.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/38.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/43.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1454355.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of the main technical quality indicators.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El libro blanco de la nefrología española (I)" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Sociedad Española de Nefrología" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nefrologia" "fecha" => "2000" "volumen" => "20" "paginaInicial" => "109" "paginaFinal" => "129" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10853192" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El libro blanco de la nefrología española (II)" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Sociedad Española de Nefrología" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nefrologia" "fecha" => "2000" "volumen" => "20" "paginaInicial" => "214" "paginaFinal" => "233" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10916999" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El libro blanco de la nefrología española (III)" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Sociedad Española de Nefrología" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nefrologia" "fecha" => "2000" "volumen" => "20" "paginaInicial" => "396" "paginaFinal" => "402" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11100659" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improving quality improvement using achievable benchmarks for physician feedback: a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Kiefe" 1 => "J.J. Allison" 2 => "O.D. Williams" 3 => "S.D. Person" 4 => "M.T. Weaver" 5 => "N.W. Weissman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2001" "volumen" => "285" "paginaInicial" => "2871" "paginaFinal" => "2879" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11401608" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "¿Es posible mejorar nuestros resultados en hemodiálisis? Establecimiento de objetivos de calidad, retroalimentación <span class="elsevierStyleItalic">(feedback)</span> y <span class="elsevierStyleItalic">benchmarking</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.D. Arenas" 1 => "F. Álvarez-U de" 2 => "A. Moledous" 3 => "T. Malek" 4 => "M.T. Gil" 5 => "A. Soriano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Nefrologia" "fecha" => "2008" "volumen" => "28" "paginaInicial" => "397" "paginaFinal" => "406" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18662147" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673613608570" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Changing physicians’ behavior: what works and thoughts on getting more things to work" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.M. Grimshaw" 1 => "M.P. Eccles" 2 => "A.E. Walker" 3 => "R.E. Thomas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/chp.1340220408" "Revista" => array:6 [ "tituloSerie" => "J Contin Educ Health Prof" "fecha" => "2002" "volumen" => "22" "paginaInicial" => "237" "paginaFinal" => "243" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12613059" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Expert consensus on the desirable characteristics of review criteria for improvement of health care quality" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H.M. Hearnshaw" 1 => "R.M. Harker" 2 => "F.M. Cheater" 3 => "R.H. Baker" 4 => "G.M. Grimshaw" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Qual Health Care" "fecha" => "2001" "volumen" => "10" "paginaInicial" => "173" "paginaFinal" => "178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11533425" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Grupo de Trabajo e Iniciativa ORD (Optimizando Resultados en Diálisis" "tituloTraducido" => "Optimising Results in Dialysis)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Aljama" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.pre2012.Aug.11674" "Revista" => array:7 [ "tituloSerie" => "Nefrologia" "fecha" => "2012" "volumen" => "32" "paginaInicial" => "701" "paginaFinal" => "703" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23169351" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0165032715001421" "estado" => "S300" "issn" => "01650327" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Funciones del facultativo especialista de área de nefrología y su importancia en el sistema sanitario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Pascual" 1 => "M. Rivera" 2 => "M. Fernández" 3 => "A. Tato" 4 => "T. Cano" 5 => "M.T. Tenorio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nefrologia" "fecha" => "2003" "volumen" => "23" "paginaInicial" => "200" "paginaFinal" => "210" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12891934" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Instituto de gestión clínica para las enfermedades nefrourológicas: utilidad de un programa de calidad asistencial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Santiñá" 1 => "P. Arrizabalaga" 2 => "A. Prat" 3 => "A. Alcaraz" 4 => "J.M. Campistol" 5 => "A. Trilla" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.2009.29.2.4988.en.full" "Revista" => array:7 [ "tituloSerie" => "Nefrologia" "fecha" => "2009" "volumen" => "29" "paginaInicial" => "118" "paginaFinal" => "122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19396316" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0890856713008794" "estado" => "S300" "issn" => "08908567" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003700000003/v1_201707070022/S2013251417301086/v1_201707070022/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003700000003/v1_201707070022/S2013251417301086/v1_201707070022/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301086?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 8 | 15 |
| 2024 October | 41 | 24 | 65 |
| 2024 September | 47 | 22 | 69 |
| 2024 August | 59 | 58 | 117 |
| 2024 July | 30 | 25 | 55 |
| 2024 June | 58 | 33 | 91 |
| 2024 May | 45 | 27 | 72 |
| 2024 April | 42 | 33 | 75 |
| 2024 March | 40 | 24 | 64 |
| 2024 February | 27 | 28 | 55 |
| 2024 January | 29 | 27 | 56 |
| 2023 December | 25 | 24 | 49 |
| 2023 November | 26 | 37 | 63 |
| 2023 October | 29 | 31 | 60 |
| 2023 September | 25 | 29 | 54 |
| 2023 August | 33 | 21 | 54 |
| 2023 July | 35 | 24 | 59 |
| 2023 June | 30 | 24 | 54 |
| 2023 May | 46 | 27 | 73 |
| 2023 April | 27 | 17 | 44 |
| 2023 March | 54 | 24 | 78 |
| 2023 February | 36 | 22 | 58 |
| 2023 January | 28 | 25 | 53 |
| 2022 December | 53 | 39 | 92 |
| 2022 November | 51 | 36 | 87 |
| 2022 October | 55 | 28 | 83 |
| 2022 September | 39 | 36 | 75 |
| 2022 August | 39 | 51 | 90 |
| 2022 July | 32 | 41 | 73 |
| 2022 June | 29 | 44 | 73 |
| 2022 May | 36 | 37 | 73 |
| 2022 April | 27 | 47 | 74 |
| 2022 March | 42 | 36 | 78 |
| 2022 February | 32 | 42 | 74 |
| 2022 January | 31 | 33 | 64 |
| 2021 December | 32 | 47 | 79 |
| 2021 November | 39 | 32 | 71 |
| 2021 October | 42 | 57 | 99 |
| 2021 September | 22 | 38 | 60 |
| 2021 August | 24 | 39 | 63 |
| 2021 July | 26 | 30 | 56 |
| 2021 June | 20 | 28 | 48 |
| 2021 May | 38 | 38 | 76 |
| 2021 April | 60 | 77 | 137 |
| 2021 March | 44 | 40 | 84 |
| 2021 February | 31 | 25 | 56 |
| 2021 January | 21 | 23 | 44 |
| 2020 December | 13 | 14 | 27 |
| 2020 November | 20 | 15 | 35 |
| 2020 October | 23 | 22 | 45 |
| 2020 September | 20 | 14 | 34 |
| 2020 August | 29 | 15 | 44 |
| 2020 July | 24 | 10 | 34 |
| 2020 June | 21 | 15 | 36 |
| 2020 May | 16 | 9 | 25 |
| 2020 April | 15 | 16 | 31 |
| 2020 March | 22 | 12 | 34 |
| 2020 February | 22 | 20 | 42 |
| 2020 January | 29 | 18 | 47 |
| 2019 December | 29 | 25 | 54 |
| 2019 November | 26 | 22 | 48 |
| 2019 October | 18 | 10 | 28 |
| 2019 September | 30 | 9 | 39 |
| 2019 August | 22 | 14 | 36 |
| 2019 July | 24 | 20 | 44 |
| 2019 June | 23 | 14 | 37 |
| 2019 May | 23 | 21 | 44 |
| 2019 April | 24 | 38 | 62 |
| 2019 March | 30 | 18 | 48 |
| 2019 February | 21 | 18 | 39 |
| 2019 January | 21 | 12 | 33 |
| 2018 December | 136 | 39 | 175 |
| 2018 November | 258 | 14 | 272 |
| 2018 October | 238 | 22 | 260 |
| 2018 September | 92 | 15 | 107 |
| 2018 August | 45 | 25 | 70 |
| 2018 July | 46 | 20 | 66 |
| 2018 June | 52 | 13 | 65 |
| 2018 May | 67 | 16 | 83 |
| 2018 April | 119 | 11 | 130 |
| 2018 March | 107 | 11 | 118 |
| 2018 February | 115 | 7 | 122 |
| 2018 January | 79 | 4 | 83 |
| 2017 December | 139 | 4 | 143 |
| 2017 November | 45 | 7 | 52 |
| 2017 October | 30 | 7 | 37 |
| 2017 September | 37 | 10 | 47 |
| 2017 August | 26 | 2 | 28 |
| 2017 July | 54 | 15 | 69 |
| 2017 June | 6 | 1 | 7 |
Show all
